Acceptability of a peer-led self-management program for people living with chronic obstructive pulmonary disease in regional Southern Tasmania in Australia: A qualitative study.

OBJECTIVES: People living with chronic obstructive pulmonary disease (COPD) in regional communities experience a higher disease burden and have poorer access to support services. This study sought to investigate the acceptability of a peer-led self-management program (SMP) in regional Tasmania, Australia. METHODS: This descriptive qualitative study, underpinned by interpretivism used semi-structured one-to-one interviews to gather data to explore COPD patients' views of peer-led SMPs. Purposeful sampling recruited a sample of 8 women and 2 men. Data was analysed using a thematic approach. RESULTS: The three final themes, 'Normality and Living with the disease', a 'Platform for sharing' and 'Communication mismatch' suggest that peer-led SMPs could offer an opportunity to share experiences. The themes also suggest that COPD often manifested as a deviation from 'normal life'. Communication was often felt to be ambiguous leading to tension between the health experts and people living with the condition. DISCUSSION: Peer-led SMP has the potential to provide the much-needed support for people living with COPD in regional communities. This will ensure that they are empowered to live with the condition with dignity and respect. Benefits of exchanging ideas and socialisation should not be ignored and may enhance sustainability of SMPs.

A meta aggregation of qualitative research on retention of general practitioners in remote Canada and Australia.

OBJECTIVE: Our aim was to systematically review qualitative evidence regarding the experiences and perceptions of general practitioners and what factors influence their retention in remote areas of Canada and Australia. The objectives were to identify gaps and inform policy to improve retention of remote general practitioners, which should in turn improve the health of our marginalised remote communities. DESIGN: Meta-aggregation of qualitative studies. SETTING: Remote general practice in Canada and Australia. PARTICIPANTS: General practitioners and general practice registrars who had worked in a remote area for a minimum of one year and/or were intending to stay remote long term in their current placement. RESULTS: Twenty-four studies were included in the final analysis. A total of 811 participants made up the sample with a length of retention ranging from 2 to 40 years. Six synthesised findings were identified from a total of 401 findings; these were around peer and professional support, organisational support, uniqueness of remote lifestyle and work, burnout and time off, personal family issues and cultural and gender issues. CONCLUSIONS: Long term retention of doctors in remote areas of Australia and Canada is influenced by a range of negative and positive perceptions, and experiences with key factors being professional, organisational, or personal. All six factors span a spectrum of policy domains and service responsibilities and therefore a central coordinating body could be well placed to implement a multifactorial retention strategy.

Exclusive Breastfeeding and the Acceptability of Donor Breast Milk for Sick, Hospitalized Infants in Kupang, Nusa Tenggara Timur, Indonesia: A Mixed-Methods Study.

BACKGROUND: The eastern Indonesian province of Nusa Tenggara Timur (NTT) has an infant mortality rate of 45 per 1000, higher than the national average (28/1000). Exclusive breastfeeding, important for improving newborn and infant survival, is encouraged among hospitalized infants in Kupang, the provincial capital of NTT. However, barriers to hospitalized infants receiving breast milk may exist. OBJECTIVES: This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang, NTT. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored. METHODS: A mixed-methods study using a convergent parallel design was conducted. A convenience sample of 74 mothers of hospitalized infants and 8 hospital staff participated in semi-structured interviews. Facility observational data were also collected. Analysis was conducted using Davis's barrier analysis method. RESULTS: Of the 73 questionnaires analyzed, we found that 39.7% of mothers retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Expressing was associated with maternal reported exclusive breastfeeding χ(2) (1, N = 73) = 6.82, P = .009. Staff supported breastfeeding for sick infants, yet mothers could only access infants during set nursery visiting hours. No mothers used DBM, and most mothers and staff found the concept distasteful. CONCLUSIONS: Increasing mothers' opportunities for contact with infants is the first step to increasing exclusive breastfeeding rates among hospitalized infants in Kupang. This will facilitate mothers to express their breast milk, improve the acceptability of DBM, and enhance the feasibility of establishing a DBM bank.